Therapeutic Plasma Exchange for Anti-Aging: Why I’ve Personally Decided Against It

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by Nils Osmar August 30, 2026

This article is not intended as and should not be taken as medical advice.

1. What’s TPE?

TPE (also known as apheresis) is a well-established 50-year-old medical procedure that some people in our community have been repurposing for longevity on the strength of one small randomized trial and one tiny uncontrolled pilot. Both studies had significant funding conflicts, and both used surrogate biomarkers rather than health outcomes.

The price varies but is high. I checked locally in Seattle and found that the price floor is about $5,000/session. The Circulate-branded “longevity protocol” runs $8,000–$10,000/session. The trial protocol was six sessions. So we’re looking at around $50,000-60,000, plus the cost of the lab work. TPE is a big business and a major source of revenue for the clinics that conduct it.

2. How it works

Blood is drawn through an IV, run through a centrifuge or filter that separates plasma from cells. The plasma is discarded, and the cells are returned along with a replacement fluid — normally 5% albumin in saline. A standard 1.0–1.5 plasma-volume exchange removes roughly 60–70% of any given plasma protein in one pass. Each session can run 2 or 3 hours.

TPE is not selective. It doesn’t pick and choose the “bad things” in our blood and remove them. It removes inflammatory cytokines (which should presumably be beneficial), but also removes immunoglobulins, clotting factors, hormones, and lipoproteins.

3. Why it works (to the extent that it does):

  1. Dilution of pro-geronic factors (Conboy lab, Berkeley). The old blood being removed carries pro-aging factors, leaving fewer in our bodies at the end of the procedure.
  2. Removal of senescence-associated proteins
  3. Immune reset — TPE restores a more youthful lymphoid/myeloid balance.
  4. Xenobiotic clearance — TPE removes microplastics, PFAS, and heavy metals from our bloodstreams — simply because it’s removing the blood that contains these particles. This clearance is the newest marketing angle and the least substantiated. (It reminds me honestly of the claims that have been made for the health benefits of chelation therapy, which have a history of being greatly exaggerated.)

4. The evidence

The key trial — Fuentealba et al., Aging Cell, May 2025

DesignSingle-blind, placebo-controlled, randomized
n42, age 50+
ArmsBiweekly TPE · Biweekly TPE + IVIG · Monthly TPE · Control
ProtocolSix exchanges over the treatment period
OutcomeComposite “biological age” from multi-omics — epigenome, proteome, metabolome, glycome, immune profiling

Results: TPE + IVIG every two weeks showed a mean −2.61 years biological age; TPE alone −1.32 years. Secondary findings: more youthful immune cell composition, reduced senescence-associated proteins, some gains in balance and strength. Effects were largest in participants with worse baseline markers (elevated bilirubin, glucose, liver enzymes) — i.e. the least healthy benefited most.

The caveat: Benefits largely plateaued after the first three sessions, with diminishing returns thereafter.

Conflicts: The study was funded by Circulate, Inc. Senior author David Furman and Buck Institute CEO Eric Verdin are both Circulate co-founders. The company that sells the treatment funded the trial that validated it, and its founders wrote the paper. Independent verification of the results doesn’t yet exist. This does not necessarily prove that the results of the study were slanted, but it’s a concern that we need to be aware of when evaluating the claims made by the proponents of the procedure

Worth noting: Dr. Jeffrey Winters of the Mayo Clinic, an apheresis specialist, stated that the findings “do not show the therapy leads to longer or healthier lives.”

The pilot — Kiprov, Conboy et al., GeroScience, 2022

Participants were ages 46–77. The study was uncontrolled. They had multiple TPE rounds over months with saline/albumin replacement. Reported reductions in CCL20, IL-16, TLR4, p16, 8-OHdG, TDP-43, and a restored lymphoid/myeloid ratio. Biological age reductions were reported as “decades” — but measured with a novel 10-protein “noise” biomarker the authors invented for this paper, not a validated clock.

What does not exist

  • Any hard endpoint.
  • No mortality, no incident disease, no functional decline data over years.
  • Independent (non-Circulate-funded) replication.
  • Trials long enough to detect harm from repeated plasma protein depletion in healthy people.
  • Any dosing science. Six sessions is a number from one trial, not an established protocol — and that trial’s own data suggest three may be where the curve flattens.
  • Aging is not an ASFA-recognized indication at any category level.

The Pheno Age Problem

Reversing biological age based on epigenetic markers is promising. But if TPE works, it should show benefits in terms of Pheno Age. It took some digging, but I found that:

  • There has only been one study looking at PhenoAge.
  • It found no rejuvenation or improvement.
  • Several biomarkers in fact moved the wrong way.
  • The blood panels showed albumin, total protein, calcium and phosphorus all falling while homocysteine rose.
  • The authors flagged the calcium loss as an osteoporosis signal and the homocysteine as cardiovascular risk.
  • Lipids did improve somewhat, but ApoA fell alongside them.

TPE is still promising (in my opinion) because…

  • The biology is plausible. The dilution hypothesis makes intiutitive sense.
  • With that said, it’s worth remembering that TPE has not been proven to reduce mortality in humans.
  • It has also not been proven to extend lifespan. But we should take this caveat with a grain of salt because no intervention has. Humans are simply too long lived to know whether TPE or any other anti-aging intervention is effective at extending either lifespan or health span.

5. Risks

The overall adverse event rate in apheresis is 4–5% of procedures.

Complications can include:

  • Citrate-induced hypocalcemia — the most frequent problem. Perioral and peripheral tingling, nausea, muscle spasms; severe cases of arrhythmia or seizure.
  • Hypotension / syncope — ~11 severe events per 10,000 procedures, the leading cause of procedure interruption.
  • Urticaria (a skin condition characterized by itchy, raised red or skin-colored welts that can appear anywhere on the body) has been reported in 0.7–12% of procedures.
  • Vascular access issues: hematoma related to repeated punctures of the skin.

Concerns specific to repeated use in healthy people:

  • Immunoglobulin depletion. Each session strips ~60% of our IgG; recovery takes weeks.
  • Repeated exchanges without IVIG replacement can leave the patient transiently hypogammaglobulinemic.
  • Coagulation factor depletion, particularly fibrinogen.
  • Repeated albumin exposure.
  • Unknown long-run effects of periodically removing large fractions of the plasma proteome from someone who is healthy. Everything we know about TPE safety comes from sick people treated for a defined episode. A procedure can have clinical benefits for someone who is suffering from an illness, but for those who are well, the potential for dangerous side effects has to be considered in relation to the possible risks.

My thoughts:

  • The truth is that I have mixed feelings about TPE. I’m not personally planning to pursue it.
  • Every medical procedure can have benefits and side effects. I still think TPE is promising. But for me, both the financial cost and the potential for side effects (for a promising but unproven procedure) give me pause.
  • It makes more sense, in my opinion, to put my resources into interventions that are known to improve mortality and support cardiovascular health such as a well structured exercise program.
  • TPE is, from my perspective, being promoted more vigorously than the evidence suggests makes sense.
  • Clinics, as noted above, make a fortune from offering this procedure. That doesn’t necessarily make it the best option from the patient’s perspective.

This article began as a research project that I conducted with the assistance of Claude Fable 5. Parts of the initial draft were written by Claude; others, by me. I edited and rewrote the portions Claude had written, and I am responsible for any errors. This article is not intended as and should not be taken as medical advice.

Bibliography

Primary studies

Guidelines and safety data

Reporting and commentary

Nils Osmar is the Director of Rekindle School, an independent educational program in Seattle, Washington, established in 2002. He has several websites, exploring questions related to:

• Consciousness in today's Large Language Models

• Life extension and anti-aging

• News, politics, culture and the arts

Unless otherwise indicated, Nils is the author of all of the articles on this site. 

© Nils Osmar 2026.

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